Repeat surgical interventions following "definitive" instrumentation and fusion for idiopathic scoliosis

STUDY DESIGN. A retrospective chart review was performed on all idiopathic scoliosis patients treated with instrumented spinal fusion over a 15-year period. OBJECTIVES. To provide an experience from a single institution over a prolonged time period. The goal was to determine the frequency of repeat surgical interventions following the "definitive" spinal fusion surgery and identify the factors responsible for these reoperations. SUMMARY OF BACKGROUND DATA. Instrumented spinal fusion remains the standard of care in the surgical management of idiopathic scoliosis. This surgery is considered a "definitive" procedure where, barring a complication, no additional surgical procedures are planned. Although many studies have reported the frequency of specific complications following spinal fusion, little information currently exists regarding the cumulative average of these repeat surgical interventions that occur following these "definitive" procedures. METHODS. Surgical logs were reviewed on all patients who had an instrumented spinal fusion for idiopathic scoliosis from January 1988 through December 2002. All subsequent surgical interventions on these patients were then identified from the logs through December 2004. Pertinent information was gleaned from surgical logs and patient charts to provide details for these reoperations. RESULTS. A total of 1,046 patients underwent an instrumented spinal fusion for idiopathic scoliosis: 809 had a posterior-only fusion, 228 had an anterior-only fusion, and 9 had a combined anterior/posterior spinal fusion. A total of 172 repeat surgical interventions were performed in 135 patients (12.9%). Of these 135 patients, 29 patients (21.5%) had two or more separate procedures performed. The most common reasons for reoperation were infection, symptomatic implant, and pseudarthrosis. Patients who had posterior fusions had a significantly higher rate of reoperation than patients who had anterior fusions (14.0% vs. 9.3%). Reoperations due to infections and symptomatic implants occurred with significantly higher frequency in the posterior spine fusion group compared with those with anterior spinal fusion. No differences in rates of reoperation for pseudarthrosis were noted between posterior and anterior fusion groups. CONCLUSIONS. Repeat surgical interventions are relatively common following these supposedly definitive surgical procedures. The most common reasons for return to surgery are infection, symptomatic implant, and pseudarthrosis.